In what may prove to be the biggest shift in emergency care of cardiac arrest in 40 years, cities across the country are leading a move away from the familiar practice of using mouth-to-mouth resuscitation. (Related story: Many 911 dispatchers eliminating mouth-to-mouth)

In its place, the cities are recommending simple chest compressions — pushing down repeatedly on the victim's chest — to mimic a steady heartbeat. The emergency medical directors who are behind the shift say research in Seattle and Richmond, Va., suggests it will save many lives. (Related story: People die in just a few seconds lost)

The movement became a full-fledged national trend last week at a meeting of emergency medical services (EMS) medical directors from 21 of the nation's largest cities. Doctors from a dozen cities, including New York, Los Angeles and Chicago, decided to make the switch. They join at least seven other cities that already are advising 911 callers to do chest compressions without mouth-to-mouth "rescue breathing."

Seattle saved more lives by advising compressions alone, and Richmond rescuers arrived to find 10 times more victims (60% vs. 6%) getting lifesaving compressions when not distracted by advice on breathing techniques.

Cities that are on board

These cities are following the lead of at least seven other cities that have simplified 911 rescue instructions to increase cardiac-arrest survival:

For now, the shift applies primarily to untrained bystanders, the group most likely to reach victims in the first critical minutes. In such emergencies, lives generally are saved or lost within six minutes. The emergency directors agreed that trying to talk 911 callers through mouth-to-mouth procedures was doing more harm than good because it wasted time.

The American Heart Association is considering similar changes to its guidelines, but a decision is not expected until 2005. In the meantime, the switch is well on its way to becoming standard practice.

"We are convinced this is the appropriate thing to do," says Corey Slovis, EMS medical director in Nashville, where new instructions will begin within two weeks. "People are very excited about this."

James Loflin, medical director in El Paso, says his city changed Monday.

Larger cities say it will take weeks, perhaps months, to make the change. "We want the fire department and the legal folks to look at it," says Neal Richmond, deputy medical director in New York.

The medical directors are taking action before the heart association does, partly in response to findings from a USA TODAY series published in July. The 18-month investigation by the newspaper found that at least 1,800 people die needlessly each year in the nation's 50 largest cities because EMS care is fragmented, inconsistent and slow.

While the heart association would prefer that all adults be trained in CPR so that they can practice their skills before they are faced with a crisis, officials with the association agree that immediately beginning compressions alone is better than waiting even a minute or two to begin CPR. "We strongly support this," says Mike Bell, vice president for emergency cardiovascular care programs. "This gets something done."